Provider Demographics
NPI:1043515505
Name:BACK IN ACTION CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:GILLIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-634-2579
Mailing Address - Street 1:824 E FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6375
Mailing Address - Country:US
Mailing Address - Phone:719-634-2579
Mailing Address - Fax:719-342-2379
Practice Address - Street 1:824 E FILLMORE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6375
Practice Address - Country:US
Practice Address - Phone:719-634-2579
Practice Address - Fax:719-634-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6562261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service